Knowledge, attitudes and practices towards suicide among immigrants from the horn of Africa in Victoria, Australia.

This study explored suicide risks and protective factors in the first generation-immigrants to Victoria, Australia, from five countries of the Horn of Africa. The aim was to contribute towards an effective and culturally sensitive interventions to prevent suicide. The research used a survey study of knowledge, attitudes and practices towards suicide, in representative samples recruited from each community using snowball sampling. The results identified three major risk factors including, (1) lack of interface between community resources and support services, (2) prevalent negative attitudes towards suicide, and (3) gaps in suicide awareness. The roles of religious and community leaders and spiritual healers were identified as protective factors providing the communities with support to deal with suicide and other mental health issues. In conclusion, the overall impact of these risk factors was that they lead to delayed lifesaving interventions, thus contributing to an increased likelihood of suicide incidents or other adverse outcomes. These protective factors have a key role to serve as a link between the communities and health services, to address issues of delay in accessing services as well as to address negative attitudes towards suicide and the gaps in suicide literacy.

HIV seroconversions among male non-occupational post-exposure prophylaxis service users: a data linkage study.

BACKGROUND: Despite widespread prescription of non-occupational post-exposure prophylaxis (NPEP) in Victoria, little is known about subsequent HIV acquisition among NPEP users. We linked the Victorian NPEP Service (VNPEPS) database and the Victorian HIV Surveillance Registry to determine the number, incidence rate and predictive factors of HIV seroconversions among users of the VNPEPS. METHODS: Records from male patients that received NPEP in the VNPEPS database (n = 1420) between January 2001 and February 2008 were linked with all entries in the Victorian HIV Surveillance Registry up to May 2008. RESULTS: Sixty-one men who presented to the VNPEPS were identified as HIV seropositive; 16 of these were diagnosed at initial presentation for NPEP. The incidence of HIV seroconversion in males who were HIV seronegative at first presentation for NPEP was 1.27 (95% confidence interval 0.95-1.70) per 100 person-years. There was no association between HIV seroconversion and number of NPEP presentations or age. The median age of seroconversion was 34.6 years. CONCLUSION: The incidence of HIV infection among men presenting to the VNPEPS is slightly lower than the HIV incidence in NPEP users in a recent Australian cohort study of men who have sex with men, but higher than HIV incidence in general gay male populations. Frequency of NPEP use was not associated with risk of HIV seroconversion. Examination of risk behaviour before and after NPEP use in this population is required to further assess the impact of NPEP availability and use on HIV incidence rates and risk behaviour in Australia.

Factors influencing a self-limiting HIV outbreak among ethnic Vietnamese injecting drug users in Melbourne, Australia.

Successful HIV prevention programs-such as sterile needle and syringe programs-have ensured that incidence and prevalence of HIV among people who inject drugs remains low in Australia. However, between 1999 and 2006, 20 of the 46 injecting-related HIV notifications in Melbourne (Australia's second-largest city) were ethnic Vietnamese heroin users. Through in-depth interviews we explored and documented the coping tactics and strategies of 9 ethnic Vietnamese heroin injectors. We explored their experiences of living with HIV, and in this article identify factors that appear to have contributed to limiting the spread of HIV beyond this cluster of people. The data reveal factors associated with this self-limiting outbreak, including consciously avoiding opioid withdrawal and having closed injecting networks. Early and effective engagement with participants by health care workers also appears to have played an important role in containing the transmission of HIV within this group of ethnic Vietnamese heroin injectors.

Delayed diagnosis of HIV infection in Victoria 1994 to 2006.

BACKGROUND: The identification of factors associated with delayed diagnosis of HIV infection in Victoria, Australia was the aim of the present study. METHODS: Demographic and epidemiological characteristics of cases notified to the Victorian HIV surveillance database between 1 January 1994 and 31 December 2006 were analysed. Delayed diagnosis was defined as: CD4 count below 200 cells mm(-3) at HIV diagnosis or diagnosis of AIDS earlier than 3 months after HIV diagnosis. RESULTS: Diagnosis of HIV was delayed in 627 (22.6%) of 2779 cases. Of these, 528 (84.2%) had either a high-risk exposure or were born in a high-prevalence country. The most common exposure was male homosexual contact in 64.3% of cases. Independent risk factors for delayed diagnosis were: older age at diagnosis (30-39 years odds ratio [OR] 2.15, > or = 50 years OR 7.50, P < 0.001), exposure via routes other than male homosexual sex or injecting drug use (heterosexual sex OR 2.51, P < 0.001, unknown/other route OR 4.24, P < 0.001); birth in Southern/Eastern Europe (OR 2.54), South-east Asia (OR 2.70) or the Horn of Africa/North Africa (OR 3.71, P < 0.001), and male gender (OR 0.47 for females, P < 0.001). CONCLUSION: Delay in the diagnosis of HIV infection is common in Victoria, but potentially avoidable in the majority of cases. Most people with delayed diagnosis had a history of male homosexual contact, injecting drug use, birth in a high-prevalence country or sexual contact with such individuals. An accurate sexual history, together with knowledge of their country of birth, should identify most individuals who should be offered an HIV test.

The impact of immigration on the burden of HIV infection in Victoria, Australia.

BACKGROUND: Accurate estimates of the number of people diagnosed and living with HIV infection within a health jurisdiction provide the basis for planning of clinical service provision. Case reporting of new diagnoses does not account for inwards and outwards migration of people with HIV infection, thereby providing an inaccurate basis for planning. METHODS: The Victorian passive surveillance system records all cases of HIV diagnosed in Victoria and distinguishes between new Victorian diagnoses (cases whose first ever HIV diagnosis was in Victoria) and cases previously diagnosed interstate and overseas. In order to gain an understanding of the impact of population movement on the burden of HIV infection in Victoria, we compared the characteristics of people first diagnosed in Victoria with those previously diagnosed elsewhere. RESULTS: Between 1994 and 2007 there were 3111 HIV notifications in Victoria, including 212 (7%) 'interstate diagnoses' and 124 (4%) 'overseas diagnoses'. The proportion of cases diagnosed outside Victoria increased from 6.4% between 1994 and 2000 to 13.8% between 2001 and 2007. Compared with 'new diagnoses', a larger proportion of 'interstate diagnoses' reported male-to-male sex as their HIV exposure, were Australian-born and diagnosed in Victoria at a general practice specialising in gay men's health. Compared with 'new diagnoses', a larger proportion of 'overseas diagnoses' were female, reported heterosexual contact as their HIV exposure, and were diagnosed in Victoria at a sexual health clinic. CONCLUSIONS: Between 1994 and 2007 more than 10% of Victorian HIV diagnoses were among people previously diagnosed elsewhere. Characteristics of both interstate and overseas diagnoses differed from new diagnoses. Service planning needs to be responsive to the characteristics of people moving to Victoria with previously diagnosed HIV infection.

Estimating community incidence of Salmonella, Campylobacter, and Shiga toxin-producing Escherichia coli infections, Australia.

To estimate multipliers linking surveillance of salmonellosis, campylobacteriosis, and Shiga toxin-producing Escherichia coli (STEC) infections to community incidence, we used data from a gastroenteritis survey and other sources. Multipliers for severe (bloody stool/long duration) and milder cases were estimated from the component probabilities of doctor visit, stool test, sensitivity of laboratory test, and reporting to surveillance system. Pathogens were classified by the same severity criteria and appropriate multipliers applied. Precision of estimates was quantified by using simulation techniques to construct 95% credible intervals (CrIs). The multiplier for salmonellosis was estimated at 7 (95% CrI 4-16), for campylobacteriosis at 10 (95% CrI 7-22), and for STEC at 8 (95% CrI 3-75). Australian annual community incidence rates per 100,000 population were estimated as 262 (95% CrI 150-624), 1,184 (95% CrI 756-2,670), and 23 (95% CrI 13-54), respectively. Estimation of multipliers allows assessment of the true effects of these diseases and better understanding of public health surveillance.

Australia's notifiable diseases status, 2005: annual report of the National Notifiable Diseases Surveillance System.

In 2005, 60 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 125,461 cases of communicable diseases to the National Notifiable Diseases Surveillance System: an increase of 10% on the number of notifications in 2004. In 2005, the most frequently notified diseases were sexually transmissible infections (51,557 notifications, 41% of total notifications), gastrointestinal diseases (29,422 notifications, 23%) and bloodborne diseases (19,278 notifications, 15%). There were 17,753 notifications of vaccine preventable diseases; 4,935 notifications of vectorborne diseases; 1,826 notification of other bacterial infections (legionellosis, leprosy, meningococcal infections and tuberculosis) and 687 notifications of zoonotic diseases.

Australia's notifiable diseases status, 2004, annual report of the National Notifiable Diseases Surveillance System.

In 2004, 60 diseases and conditions were nationally notifiable in Australia. States and Territories reported a total of 110,929 cases of communicable diseases to the National Notifiable Diseases Surveillance System (NNDSS): an increase of 4 per cent on the number of notifications in 2003. In 2004, the most frequently notified diseases were sexually transmissible infections (46,762 cases; 42% of total notifications), gastrointestinal diseases (25,247 cases; 23% of total notifications) and bloodborne diseases (19,191 cases; 17% of total notifications). There were 13,206 notifications of vaccine preventable diseases, 6,000 notifications of vectorborne diseases, 1,799 notifications of other bacterial infections (includes, legionellosis, leprosy, meningococcal infections and tuberculosis) and 877 notifications of zoonotic diseases.

Annual report of the National Influenza Surveillance Scheme, 2004.

The National Influenza Surveillance Scheme includes data on influenza-like illness from sentinel general practitioner practices, laboratory reports of influenza from National Notifiable Diseases Surveillance Scheme and absenteeism data from a national employer. In 2004, 2,116 cases of laboratory-confirmed influenza-like illness were reported, which was 41 per cent lower than the previous year. Peak activity was recorded in September, a month later than in 2003. Influenza A was again predominant while influenza B had an increased activity compared to the previous season. Four hundred and fifty-four isolates were antigenically analysed: 342 were A (H3N2 strain), 4 were A(H1N1 strain) strains and 108 were influenza B viruses. Further antigenic drift was seen in the A(H3N2) subtype with approximately one third of all isolates antigenically distinguishable from the A/Fujian/411/2002 reference strain. Vaccination coverage indicated that 79 per cent of Australians aged over 65 years received the 2004 influenza vaccine.

Australia's notifiable diseases status, 2003 annual report of the National Notifiable Diseases Surveillance System.

In 2003, 58 diseases and conditions were notifiable at a national level in Australia. States and territories reported a total of 104,956 cases to the National Notifiable Diseases Surveillance System an increase of 3.2 per cent on the total number of notifications in 2002. In 2003, the most frequently notified diseases were sexually acquired infections (38,854, 37% of total notifications), gastrointestinal diseases (24,655 notifications, 24%) and bloodborne viruses (20,825 notifications, 20%). There were 11,113 notifications of vaccine preventable diseases, 6,780 notifications of vectorborne diseases, 1,826 notification of other bacterial infections and 903 notifications of zoonotic diseases.

Annual report of the National Influenza Surveillance Scheme, 2003.

Surveillance of influenza in Australia is based on laboratory isolation of influenza viruses, sentinel general-practitioner practices for influenza-like illness, and absenteeism data from a major national employer. In 2003, the peak in influenza activity was in August which was later than in 2002. In 2003, 3,604 laboratory-confirmed cases of influenza were notified to the National Notifiable Diseases Surveillance System, which was marginally lower than for the previous year. Ninety-four per cent of the circulating viruses were influenza A. This was the highest proportion in the last five years. Nine hundred and thirty-five isolates were antigenically analysed: 928 were A(H3), two were A(H1) strains and five were influenza B viruses. The majority (98%) of the A(H3) subtypes were A/Fujian/411/2002(H3N2)-like and have shown a significant antigenic drift. The 2003 Australian influenza vaccine contained A/Panama/2007/99, which induced 2-4-fold lower antibody response against the drifted strain. An A/Fujian/411/2002(H3N2)-like virus has been incorporated in the Australian influenza vaccine for 2004. In 2003, the influenza vaccine was given to 77 per cent of Australians aged over 65 years; the same up take as in 2002.

Severe acute respiratory syndrome surveillance in Australia.

In March 2003, the World Health Organization (WHO) issued a global alert recommending active worldwide surveillance for severe acute respiratory syndrome (SARS). This paper describes the epidemiological features of cases reported by Australian states and territories to the Australian Government Department of Health and Ageing between 17 March and 31 July 2003. There were 138 people investigated for SARS: 111 as suspect and 27 as probable. Five probable cases were reported to WHO after review of other possible diagnoses and Australia-specific exclusion criteria had been applied. An additional probable case identified by laboratory testing overseas, but who was not under investigation when in Australia, was also reported to WHO. The method by which surveillance for SARS was rapidly established provided an opportunity to examine Australia's planning and preparedness for future respiratory disease epidemics such as influenza.

Australia's notifiable diseases status, 2002: Annual report of the National Notifiable Diseases Surveillance System.

There were 57 infectious diseases notifiable at the national level in Australia in 2002. States and territories reported 100,278 cases of infectious diseases to the National Notifiable Diseases Surveillance System (NNDSS), a fall of 4 per cent compared to the number of notifications in 2001. In 2002, the most frequently notified diseases were, sexually transmitted infections (31,929 reports, 32% of total notifications), gastrointestinal infections (26,708 reports, 27% of total notifications) and bloodborne infections (23,741, 24%). There were 11,711 (12% of total) cases of vaccine preventable diseases, 3,052 (3% of total) cases of vectorborne diseases, 1,155 (1% of total) cases of zoonotic infections, two cases of quarantinable diseases (Vibrio cholerae O1) and 1,980 cases of other bacterial diseases, notified to NNDSS. Compared to 2001, notifications of sexually transmitted infections increased by 16 per cent and gastrointestinal infections by 2 per cent while bloodborne infections fell by 18 per cent. The number of notifications of chlamydial infection and Q fever were the highest since 1991 and 1995 respectively. By contrast, the number of notification for hepatitis A and measles were the lowest since 1991. For other notifiable diseases, the number of notifications was within the range of the five years between 1997 and 2002 (range = five-year mean plus or minus two standard deviations). This report also includes 2002 summary data on communicable diseases from other surveillance systems including the Laboratory Virology and Serology Reporting Scheme and sentinel general practitioner schemes.

Annual report of the National Influenza Surveillance Scheme, 2002.

Surveillance for influenza in Australia in 2002 was based on notifications to the National Notifiable Diseases Surveillance system from all states and territories, national and state-based sentinel practice consultations for influenza-like illness and reports of influenza virus isolations from a laboratory network. The impact of influenza was assessed by absenteeism data from a major national employer. Influenza A was the dominant type, 99 per cent of which were subtype H3N2 with only a single H1 isolate, which was identified as H1N2. The H3N2 isolates were closely related to the vaccine strain A/Moscow/10/99 and the A/Panama/2007/99, with less than one per cent showing genetic variation. Influenza B made up 21 per cent of circulating influenza and the majority of B strains were of the B/Victoria lineage, but had a haemagglutinin closely related to the B/Hong Kong/330/2001 strain. This strain was associated with two outbreaks but a proportion of vaccinees with the 2002 vaccine showed protective antibody titres. The 2002 influenza vaccine was given to 77 per cent of Australians over 65 years.

An outbreak of gastrointestinal illness associated with the consumption of escolar fish.

An outbreak of gastrointestinal illness occurred amongst attendees of a conference lunch in the Hunter area, New South Wales, in October 2001. A distinctive symptom reported by many ill persons was the presence of oily diarrhoea. The Hunter Public Health Unit investigated the outbreak by conducting a telephone interview of the cohort of conference attendees using a standard questionnaire. Twenty persons out of 44 attendees (46%) became ill following the conference. The median incubation period was 2.5 hours (range 1-90 hours). The most common symptoms reported were; diarrhoea (80%)-38 per cent of these reported oily diarrhoea; abdominal cramps (50%); nausea (45%); headache (35%) and vomiting (25%). For analyses, a case was defined as a person who developed oily diarrhea, or diarrhoea within 48 hours, or had at least two other symptoms of gastroenteritis within 6 hours, of the conference lunch. Seventeen persons had symptoms that met the case definition. None of the foods or beverages consumed were significantly associated with illness, however, all cases had consumed fish and none of those who did not eat fish (4 persons) became ill. Moreover, only 'fish' or 'potato chips' could explain a significant proportion of the illness. Analysis of the oil composition of the fish consumed was consistent with the known profile of the species marketed as 'escolar'. Among those who consumed fish the following potential risk factors did not have a significant association with the illness; Body Mass Index, age, health status and the amount of fish consumed. We concluded that consumption of fish within the marketing group escolar can cause severe abdominal cramping, nausea and vomiting, in addition to incontinent diarrhoea.